Encyclopedia of

Hip osteotomy

Definition

A hip osteotomy is a surgical procedure in which the bones of the hip
joint are cut, reoriented, and fixed in a new position. Healthy cartilage
is placed in the weight-bearing area of the joint, followed by
reconstruction of the joint in a more normal position.

Purpose

To understand hip surgery, it is helpful to have a brief description of
the structure of the human hip. The femur, or thigh bone, is connected to
the knee at its lower end and forms part of the hip joint at its upper
end. The femur ends in a ball-shaped piece of bone called the femoral
head. The short, slanted segment of the femur that lies between the
femoral head and the long vertical femoral shaft is called the neck of the
femur. In a normal hip, the femoral head fits snugly into a socket called
the acetabulum. The hip joint thus consists of two parts, the pelvic
socket or acetabulum, and the femoral head.

The hip is susceptible to damage from a number of diseases and disorders,
including arthritis, traumatic injury, avascular necrosis, cerebral palsy,
or Legg-Calve-Perthes (LCP) disease in young patients. The hip socket may
be too shallow, too large, or too small, or the femoral head may lose its
proper round contour. Problems related to the shape of the bones in the
hip joint are usually referred to as hip dysplasia.
Hip replacement
surgery is often the preferred treatment for disorders of the hip in
older patients. Adolescents and young adults, however, are rarely
considered for this type of surgery due to their active lifestyle; they
have few good options for alleviating their pain and improving joint
function if they are stricken by a hip disorder. Osteotomies are performed
in these patients, using the patient's own tissue in order to
restore joint function in the hip and eliminate pain. An osteotomy
corrects a hip deformity by cutting and repositioning the bone, most
commonly in patients with misalignment of certain joints or mild
osteoarthritis. The procedure is also useful for people with
osteoarthritis in only one hip who are too young for a total joint
replacement.

Demographics

The incidence of hip dysplasia is four per 1,000 live births in the
general world population, although it occurs much more frequently in Lapps
and Native Americans. In addition, the condition tends to run in families
and is more common among girls and firstborns. Acetabular dysplasia
patients are usually in their late teens to early thirties, with the
female: male ratio in the United States being 5:1.

Description

A hip osteotomy is performed under general anesthesia. Once the patient
has been anesthetized, the surgeon makes an incision to expose the hip
joint. The surgeon
then proceeds to cut away portions of damaged bone and tissue to change
the way they fit together in the hip joint. This part of the procedure may
involve removing bone from the femoral head or from the acetabulum,
allowing the bone to be moved slightly within the joint. By changing the
position of these bones, the surgeon tries to shift the brunt of the
patient's weight from damaged joint surfaces to healthier
cartilage. He or she then inserts a metal plate or pin to keep the bone in
its new place and closes the incision.

There are different hip osteotomy procedures, depending on the type of
bone correction required. Two common procedures are:

Varus rotational osteotomy (VRO), also called a varus derotational
osteotomy (VDO). In some patients, the femoral neck is too straight and
is not angled far enough toward the acetabulum. This condition is called
femoral neck valgus or just plain valgus. The VRO procedure corrects the
shape of the femoral neck. In other patients, the femoral neck is not
straight enough, in which case the condition is referred to as a femoral
neck varus.

Pelvic osteotomy. Many hip disorders are caused by a deformed acetabulum
that cannot accommodate the femoral head. In this procedure, the surgeon
redirects the acetabular cartilage or augments a deficient acetabulum
with bone taken from outside the joint.

Diagnosis/Preparation

A
physical examination
performed by a pediatrician or an orthopaedic surgeon is the best method
for diagnosing developmental dysplasia of the hip. Other aids to diagnosis
include ultrasound examination of the hips during the first six months of
life. An ultrasound study is better than an x ray for evaluating hip
dysplasia in an infant because much of the hip is made of cartilage at
this age and does not show up clearly on x rays. Ultrasound imaging can
accurately determine the location of the femoral head in the acetabulum,
as well as the depth of the baby's hip socket. An x-ray examination
of the pelvis can be performed after six months of age when the
child's bones are better developed. Diagnosis in adults also relies
on x ray studies.

To prepare for a hip osteotomy, the patient should come to the clinic or
hospital one to seven days prior to surgery. The physician will review the
proposed surgery with the patient and answer any questions. He or she will
also review the patient's medical evaluation, laboratory test
results, and x-ray findings, and schedule any other tests that are
required. Patients are instructed not to eat or drink anything after
midnight the night before surgery to prevent nausea and vomiting during
the operation.

Aftercare

Immediately following a hip osteotomy, patients are taken to the
recovery room
where they are kept for one to two hours. The patient's blood
pressure, circulation, respiration, temperature, and wound drainage are
carefully monitored.
Antibiotics
and fluids are given through the IV line that was placed in the arm vein
during surgery. After a few days the IV is disconnected; if antibiotics
are still needed, they are given by mouth for a few more days. If the
patient feels some discomfort, pain medication is given every three to
four hours as needed.

Patients usually remain in the hospital for several days after a hip
osteotomy. Most VRO patients also require a body cast that includes the
legs, which is known as a spica cast. Because of the extent of the surgery
that must be done and healing that must occur to restore the pelvis to
full strength, the patient's hip may be kept from bearing the full
weight of the upper body for about eight to 10 weeks. A second operation
may be performed after the patient's pelvis has healed to remove
some of the hardware that the surgeon had inserted. Full recovery
following an osteotomy usually takes longer than with a total hip
replacement; it may be about four to six months before the patient can
walk without assistive devices.

Risks

Although complications following hip osteotomy are rare, there is a small
chance of infection or blood clot formation. There is also a very low risk
of the bone not healing properly, surgical damage to a nerve or artery, or
poor skin healing.

Normal results

Full recovery from an osteotomy takes six to 12 months. Most patients,
however, have good outcomes following the procedure.

Alternatives

One alternative is to postpone surgery, if the patient's pain can
be sufficiently controlled with medication to allow reasonable comfort,
and if the patient is willing to accept a lower range of motion in the
affected hip.

Surgical alternatives to a hip osteotomy include:

Total hip replacement. Total hip replacement is an operation designed to
replace the entire damaged hip joint. Various prosthetic designs and
types of procedures are available. The procedure involves surgical
removal of the damaged parts of the hip joint and replacing them with
artificial components made from ceramic or metal alloys. The bearing
surface is usually made from a durable type of polyethylene, but other
materials including ceramics, newer plastics, or metals may be used.

Arthrodesis. This procedure is rarely performed as of 2003, but is
considered particularly effective for younger patients who are short in
stature and otherwise healthy. Arthrodesis relieves pain by fusing the
femoral head to the acetabulum. It has none of the limitations that a
joint replacement or other procedure imposes on the patient's
activity level. An arthrodesis is especially suited for patients with
strong backs and no other symptoms. The procedure generally requires
internal fixation with a plate and screws. The patient may be
immobilized in a cast while healing takes place. An arthrodesis can be
converted to a total hip replacement at a later date.

Pseudarthrosis. This procedure is also called a Girdlestone operation. A
pseudarthrosis involves removing the femoral head without replacing it
with an artificial part. It is performed in patients with hip infections
and those whose bones cannot tolerate a reconstructive procedure.
Pseudarthrosis leaves the patient with one leg shorter and usually less
stable than the other. After this procedure, the patient almost always
needs at least one crutch, especially for long-distance walking.

I am a 54 year old male. I had osteotomies performed on both hips aproximately 10 years ago. I am now in need of full hip replacements on both hips. I am not able to see the physician that performed these surgeries as he has moved on. As I was researching clinics that perform these types of surgeries I came across a Dr Mark J. Spangehl, M.D. who specializes in osteotomies at the Mayo Clinic in Arizona . I was told by a doctor in Pittsburgh that I will require removal of the metal pins and a 6 month recovery for each hip before I can consider complete replacements. Is there an alternative to this procedure. I am not encouraged by the fact that I will need to be off work for such a long period of time if these removal procedures require long recovery times before I can actually have hip replacements. What are my alternative options?

I am 18 years old and had the hip osteotomy surgery on my left hip in 2003. I had it at Scottish Rite Hospital in Texas since I have been going there since I was born. I had four pins placed in my hip and in 2004 had three of them removed.
To answer your questions, after the anesthesia is gone, the pain is very tolerable. Now that it has been five years since my surgery I feel a bit of an arthritis feeling in my lower back and hips when its humid outside but it's nothing a Tylenol won't help. Before I had the surgery, it was said that I might have to have the same surgery on my right hip too, but having it on my left hip aligned my right one and it wasn't necessary.
I couldn't imagine how my life would be without having the hip osteotomy surgery. It is said that if I chose not to have the surgery then I would be in a wheelchair by the time I hit 50. I would rather deal with the back pain then be immobile. I am very active and only somethings, like running for a long period, bother my hip.

My 3yr old twin daughter has Mild Cerebral Palsy,spastic dyplegia,left-sided weakness;and wears AFO braces on both her legs, she is in-toeing and you can see that it is not improving with her braces being worn.She is a patient at CRS in Phoenix Arizona,and her ortho doctor is talking about this hip procedure. is thier anyone that has had this surgery with this diagnosis and at such a young age.Please e-mail me with any information or support on this type of surgery.
Thank You;
Dawn Love

hello,
thank you a lot for the article. i learned a lot.
i have the problem you wrote about, and the doctors said i need Pelvic osteotomy. i live in Israel;and we d'ont have here a surgeon with serious experiment in this kind of surgery.
do you know a surgeon that would be able to come to israel for us? there are some more patients like me, and we suffer a lot from this problem.
i'm waitting for your answere. thank you a lot. rachel.

Hello, I am 31 years old, I have congenital hip displaysia and wore a spica cast until I was 2 years old and a brace until age 5. My orthopedist told my mother I would be in a wheelchair by the time I was 25, well 6 years later I am still walking, not well at times but still mobile. My orthopedist told me today that he believes that I am a perfect candidate for a Ganz Periacetabular osteotomy, which I am all for the only problem is there are no doctors in West Virginia that do these types of surgeries, so I guess until WV catches up with the rest of the world I will live with the pain, but I suppose by the time a surgeon that specializes in these surgeries get here I will be old enough for a hip replacement, just a shame that I wont be young enough to enjoy it.

I am 41 years old and was told that I had bilateral hip dysplesia two years ago and was told by a WVU physician that I was a candidate for the Ganz Periacetabular Osteotomy and he would not take care of the torn labrum in my right hip because I needed the "radical" Ganz procedure. He said that within the year I would have problems with my other hip and I would have to get the Ganz procedure on both hips. Two years later, no different, labrum still torn and no pain in the other hip. My doctor has held me hostage in refusing to perform arthroscopic procedure to correct labrum tear. Furthermore, my insurance would not pay a significant portion of the Ganz procedure and my WVU doctor became upset with my insurance company in attempting to find a physician that performs the Ganz procedure and recognize my insurance. Eventually, my WVU physician would not return my phone calls. I'm still waiting for another physician that can perform arthroscopic hip surgery. Good luck to all. Now I understand why they put dogs to sleep with dysplesia. So they dont have to put up with the physician...lol

hello i am 19 and i had the operation in 2007
although it is better now when i woke up the pain was unbearable because of this i am reluctant to have the outer one done. the other problem that i am having is although the pain in the corrected hip is now more tolerable it is still there is this normal?

I had bilateral hip osteotomy when I was 18 in 1995. I have not been able to walk normally since. I have a heavy gait, and people stare, and often ask why I walk the way I do. This is very embarrassing. I have excruciating pain on a daily basis. I can not stand for more then 10 minutes at a time, and something as simple as walking around the block is painful. I wished my parents had just let me be. I would have rather dealt with an occasion dislocation rather then the daily pain I have endured every day since. I strongly discourage this surgery. Wait until your old!

I have a 13 year-old granddaughter who is being scheduled for a hip osteotomy. She is very over weight. Any comments on her chances of a full recovery and how does one go about talking to her parents about losing the weight to assure her full recovery. Thank you for attention to this worrisome problem.

I am scheduled to have this hip ostoetomy. Im very nervous about what to expect after the surgery and the whole recovery. If any one can tell me details, I would appreciate it. I have had severe pain in x rmy hip and have been out of work for 4 yrs. The doctors finally diagnoised me with hip dysplasia. I have had surgery for torn cartiledge, under went mris, xrays,many different injections, including one that isnt approved by the fda. Im ready to have my life back.

I am a 15 year old boy and I am now recovering from a right hip osteotomy w/ internal fixation and it is not so bad of course I have pains every now and then but its not too bad the only thing that has me worried is that this article says some scary side effects but mainly this when you go in they oput you to sleep you want know your going in to surgery then you wake up and it feels like 5 minutes later in recovery get admitted into a room and about a couple days go home that's about it nothing to it to people who are having this or thinking about having it I suggest if you need it go for depending on your condition thx for reading need any more info send a email to the one published thx

Like many of you that have posted your stories, mine is very similar. I am a 36 year old wife and mother of 6 grade school children. I have been in pain for 10 years and had Arthroscopic Hip Surgery 8 months ago. Unfortunately, it was unsuccessful and have seen 8 doctors for help since. I am unable to work due to the pain and discomfort. I was scheduled to have a pelvic osteotomy this past Monday in Boston, 2 days prior the doc cxld due to a miscommunication in my recovery time stating I would return to work in 3 months. He had no sympathy for the pain and this surgery was more than I have ever wanted anything else in the world. He flat out refused to treat me and told me to find someone else. I am devestated and have been crying for 6 days straight thinking of starting the daunting task of finding another surgeon to help me.

Hello everyone. I am 18 years old and have hip dysplasia. I had my first pelvic osteotomy when I was 15. I had a spinal cord stroke at age 12 and left me partially paralyzed and has messed up my posture leading to my dysplasia.the first surgery was unsucessful due to the doctor at the time at WVU overseeing the real problem. Now I am in week 3 of recovering from my second osteotomy. I got it done at WVU again but by a new doctor that really knows what he's talking about. I feel great I have a plate in my femur a pin in my hip and a shelf over my hip socket made out of bone to keep it in place. I was put on 4 weeks of bedrest and cannot sit up past 45 degrees. but I go back in 5 days and I hope he says everything is good! The pain after surgery and occasional aches when it rains is nothing compared to having hip pain everyday without the surgery. Feel free to contact me. God bless!

heyy. i'm now 17 but at age 15 i finally found out that i had hip dysplasia in both of my hips. i was a cheerleader and a gymnast. i had my surgery in feburary of 2008. i had 5 pins placed in my right hip. the surgery took 6 hours and luckily Dr. John Frino at Baptist Hospital was a dysplasia specialist. he is one of the 2 in north carolina that do this surgery and he is amazing. i weigh less then 100 which at first worried everyone becuase i am underweight. but i healed better than anyone he has ever done. i was using crutches after 4 days in the hospital. the pain was bad, but it's all a matter of pushing yourself to get better. it's worth it. the pins were removed after 6 months. i was told i wouldn't be able to walk when i become 20 years old if something wasn't done about it. getting the right doctor and care really makes a difference. but i think i made a great decision by getting the surgery. i am also going to get my other hip done and i'm not hesitating one bit. it's worth it if you are in pain. i still have minimal pain and aches but they go away in no time and it's not unbearable like it used to be. i was doing back handsprings in my physical therapy with the pins still in!

When I was born, I was diagnosed with bi-lateral hip dysplasia. I wore a harness and was told it was corrected. Unfortunately, it didn't stay that way. After complaining for about 3 years of hip pain, I found out that at this point I have hip dysplasia, hip impingement and torn labrums on both sides. It has been 3 years since I have discovered all of this. At this time, I decided to postpone any surgery because doctors were not sure about ANY long-term side affects of either arthroscopic surgery with all my other issues OR the osteotomy.

So, at this point, my hips have worsened and surgery is going to have to happen. I am very glad I didn't get the arthroscopic surgery because they are now saying that because the joint is still unhealthy, there will be future tears and it will be harder to correct. So, it looks like I'm getting the big one!! Oh boy!

If anyone has information about the recovery process, I'd really really appreciate it! I am 20 right now and am freaking out about whether this is going to ruin my plans/life and if I'll graduate from college on time and all those other what-ifs! I am wondering about how long after surgery could I attend classes, how much pain am I going to be in, how long do you stay in the hospital, how long after doing the right one can I do the left one? If anyone can give me some information, that'd be great!

My daughter had pelvic Osteotomy 2 years ago after been diagnosed at 19 months with hip dysplasia. She has been doing well up until one week ago. We were away on holidays at beach and for a whole week she was very active, up early in morning and in bed late at night. On last day of our holidays she could barely put her leg to ground and was telling us her hip was sore. Ever since she seems to get darts of pain but then it subsides and she walks normal again. Any advice what this could be? Do you think she has just over done it a bit? Worried mum.

I was born in 1985 with congenital hip dysplasia. It was diagnosed early and I was placed in a body cast. In 2000, my hip was in poor condition and I ended up having a Ganz Osteotomy at the St. Louis Children’s Hospital. (I would recommend this place 150%) 10 years later my hip has taken a serious turn for the worse. It is very difficult to walk, I have had one cortisone injection by a local surgeon that helped but wore off after 2 ½ months.
I went through physical therapy, and they said it was Structural not Mechanical. I have not gone back to the Doctor who did the surgery because he is specific for children.
I am curious if anyone has had this surgery and is having the same problems as I am? I really do not know what to do. I have not had any children and would like to have children, but there is no way I can gain weight on this hip.

I am suppose to go in for derotational fermeral osteomoty procedure this July, i am 16 years old and i don't know what to expect, i am keep getting mixed opinions whether to go ahead with the procedure or not. The reason for me getting the operation is due to my knee caps frequently dislocating making me unable to participate it simple day to day things, and also sports etc. Could anybody whose had this done, tell me a bit more about there experience please? i'm so nervous !!

I have a question my daughter has hip displesia she had a close reduction it didnt work so now she ahd the surgery done she was in a cast for 10 weeks she is starting to walk but we discovered that her left leg were she had the surgery done is longer than the other and now she is walking side ways cause i think her leg is longer than the other.

I have had 2 acetabular osteotomies on my right hip and had one done on the left hip in April. The ones on the right hip weren't that bad. I have arthritis in both hips with the right being worse than the left. Congenital hip dysplasia in both hips. I'm 34 years old and have gotten to a point where the pain is really bad. Even after this last hip surgery the pain is really bad. After the right hip surgery my pain was relieved instantly. I think it really depends on how much pain you're in and how good the surgeon is. Find out how many surgeries they have done and if they've treated patients with your condition before if you have a rare disorder. The last surgery was very painful but I have a high tolerance to pain medication and have been on pain medication since I was 16 so it was hard for them to control my pain. Each time I've had surgery has been different. One surgery went really well and I had instant pain relief and felt better so I suggest having it done if you're hurting. In the long run I believe it will be worth it.

As far as one side being longer than the other, that can be corrected with a shoe build up or lift in some cases. I went through the same thing with my right hip but ended up having the surgery redone by another surgeon. The key is finding a really good surgeon who knows what they're doing. ;-)

Mt 13yr old grand daughter, who has severe cerebral palsy (quadriplegic) had a bi lateral femoral osteotomy and pelvic osteotomy on one side. We are now 24 wks post op and on the side of the pelvic osteotomy is causing an awful lot of pain, xrays have shown nothing, she has also had investigation under anaesthetic, but to no avail, she was also given a steroid injection which seemed to work for about a week then started to wear off- any thoughts or comments please!

My husband started having horrific hip pain in his late twenties. He has some anxiety problems, so our family doctor brushed it off for years, telling him he probably had early arthritis. The Dr. finally did an X-Ray and told him he had congenital hip dysplasia. Because he was young, he had an osteotomy. We had three daughters, one a newborn/breastfeeding at the time. I lived through three months of hell during his recovery. They moved in a hospital bed, he had to take the family medical leave act to keep his job, he didn't get paid for the 3 months that he didn't work, and to top all...during the surgery, the Dr. ended up breaking his hip. (A fracture occured while they were positioning the hip). We didn't think much of it at first, the Dr. assured us that he patched it up, etc. SIX years later...pain is WORSE than before, so much hardware in his hip, any Dr.'s looking at his X-rays can't even see to figure out what's going on. After an MRI, a new Dr. confirms there is no arthritis, probably just complications from the original surgery. (This is a new Dr. We realized the original one had his reputation to maintain. He keep prescribing more pain medication...never acknowledging that it could be complications from sugery). I have looked everywhere on-line to see if a fracture during a hip osteotomy surgery is a common complication. Can't find anything anywhere. Have any of you had experience like this? We are not people who think about litigation. We are a family of six, my husband can't be on his hip for more than 30 minutes, he is only 37 and his quality of life is just SO sad. I want him to walk, run, and play with our four adorable daughters. Advice? PS This new Dr. doesn't want to do hip replacement surgery yet, although the thinks that would take care of the pain. But even with all the new technology, a hip replacement may only last 20 years, he'd have to have a second one at some point, (at age 60), and a 3 surgery isn't possible, so wheelchair from 80 on? What kind of life is that?

I've had bilateral PAO surgery and it was a life-changer. I'm over 10 years post-op on both sides. My pain remains very minimal (a far cry to the experience pre-op) and I am very physically and athletically active. I strongly recommend PAO for people who are willing to get in shape pre-op, take the rehab seriously (it's a bear!), and want to have many years of activity ahead of them. Most important thing I can say to anyone considering PAO or any hip osteotomy is to have a GREAT network of supports around you, b/c it's very easy to become situationally depressed and think you're never going to be okay during the rehabilitation, which is grueling. Also, immediately post-op, the pain is UNREAL, so be ready for that, too. Good luck!

Hi I had a ganz osteotomy 6mths ago I'm still using 1 crutch and havin physio . I'm havin terrible trouble with my back the past 8weeks and I still have no feeling in the side of my leg I'm restricted in a lot of movement still and it's really starting to get me down has anyone else suffered with there back since surgery..?.

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